A disorder in which patients have psychotic

symptoms and social or occupational

dysfunction that persists for at least 6

months.

Psychosis is characterized by impaired

reality testing (inability to distinguish

reality from fantasy) with specific psychotic

symptoms like delusions and hallucinations.

Affects 1 %1 % of the general population.

8% in sibilings of affected subjects.

12% in offsprings of one affected parent.

40% in offsprings of two affected parents.

47% in subjects of affected monozygotic

twins.

I.Neurotransmitter theory1)1) Dopamine hypothesis:Dopamine hypothesis:

Schizophrenia is due to hyperactivity in brain dopaminergic pathways.

This theory is consistent with: • The efficacy of antipsychotics (dopamine receptor

antagonists).• The ability of some drugs like amphetamine that

stimulate dopaminergic activity to induce psychosis.• Presence of higher levels of dopamine receptors in

subcortical nuclei of schizophrenics.

2)2) Serotonin hypothesis:Serotonin hypothesis: Evidenced by the efficacy of serotonin-

dopamine antagonists in reducing psychotic symptoms.

II. Genetic theory Defects in long arms of chromosomes 5,11

and 18 and short arms of chromosome 19 and X chromosome.

Increase the incidence of schizophrenia in subjects related to an affected person.

III.Brain structural theory Imaging techniques showed decreased size

and impaired function in limbic system and frontal lobes.

IV.Psychosocial theoryII.Increased incidence in families with overt

criticism, hostility, and overinvolvement (high expressed emotions).

Two or more of the following must be present:Two or more of the following must be present:1) Hallucinations.2) Delusions.3) Disorganized behavior or catatonic behaviour.4) Disorganized speech.5) Negative symptoms:

1) Social withdrawal.2) Affective flattening or blunting.3) Poverty of speech or poverty of speech content.4) Thought blocking.5) Poor grooming.6) Loss of volition.

6)6) The symptoms must last at least for 6 The symptoms must last at least for 6 months.months.

7)7) Presence of significant occupational and /or Presence of significant occupational and /or social dysfunction.social dysfunction.

8)8) The condition not substance-induced or due to The condition not substance-induced or due to general medical disease. general medical disease.

I.I. Paranoid type: Paranoid type: paranoid delusions, frequent auditory hallucination.

II.II. Disorganized type: Disorganized type: disorganized speech, disorganized behaviour.

III.III. Catatonic type: Catatonic type: motoric immobility or stupor, excessive motor

activity, extreme negativism or mutism, pecularities of voluntary movements, echolalia or echopraxia.

IV.IV. Residual type: Residual type: • residual negative symptoms or attenuated positive

symptoms.

V.V. Undifferentiated type: Undifferentiated type: o criteria are not met for paranoid, disorganized, or

catatonic subtypes.

i.i. Brief psychotic disorder: Brief psychotic disorder: • One or more of delusions, hallucinations, disorganized

or catatonic behaviour, disorganized speech must be present for a duration ranges from one day to one one day to one monthmonth.

ii.ii. Schizophrenifiorm disorder: Schizophrenifiorm disorder: The same clinical manifestations as schizophrenia

except the duration of schizophreniform disorder ranges from one month to 6 monthsone month to 6 months.

iii.iii. Delusional disorder: Delusional disorder: o Nonbizarre (systematized) delusions of at least one

month’s duration, in the absence of other psychotic features.

iv.iv. Secondary psychotic disorders: Secondary psychotic disorders: Psychotic disorder due to general medical conditions

and substance-induced psychotic disorder.

A.A. HospitalizationHospitalization: for: for Diagnostic purposes. Stabilization of medication. Patients with suicidal or homicidal ideation.

B.B. Pharmacotherapy: Pharmacotherapy: New (atypical) antipsychotics “serotonin and

dopamine antagonists” (SDA): I.Mechanism of action: through blocking of serotnin

receptors and dopamine receptors. II.Efficacy: effective in both positive and negative

psychotic symptoms.III.Examples: risperidone, olanzapine, clozapine, and

quitiapine.IV.Side effects: less than old antipsychotics.

II. Old (typical) antipsychotics “dopamine receptor antagonist” (DA):

II.Mechanism of action: through blocking of dopamine receptors in mesolimbic-mesocortical pathway.

III.Efficacy: effective in positive than negative psychotic symptoms.

IV.Examples; trifluperazine, haloperidol, chlorpromazine and thioridazine.

V.Side effects: Acute dystonia: slow sustained contractions of the

trunk or limbs. Neuroleptic malignant syndrome; rigidity,

hyperpyrexia, disturbed conscious level, elevated CPK, and leucocytosis.

Parkinsonism. Hyperprolactinaemia. Orthosatic hypotension. Dry mouth, constipation.

C.C. Psychosocial therapy: Psychosocial therapy: Behavior therapyBehavior therapy; to reinforce the desired behaviours and

minimize the undesired behaviours. Group therapyGroup therapy; focusing on supporting and developing

social skills. Family therapyFamily therapy; to improve family dynamics.

D.D. Elcetro-convulsive therapy (ECT):Elcetro-convulsive therapy (ECT): Indications:

Major depressive disorder. Bipolar disorder. Schizophrenia: nonchronic, acute, especially paranoid,

catatonic, or with prominent affective symptoms. Pregnancy: drug of choice in suicidally depressed or psychotic

pregnant patients who should not receive psychotropic drugs. It is performed under general anaesthesia. Acts through remodulation of brain

neurotransmitters. About 6-12 treatments are done twice or three

times weekly according to the disease and its severity.